As many reach middle age or approach retirement, they are at or near the end of their primary parenting years. Their children may be out of college or nearing graduation and they anticipate fewer financial obligations such as tuition and more time for themselves as the need to provide care and oversight lessens.

However, an increasing number of families are finding that just as their children begin the transition to adulthood and independence, their elderly parents need their help. Sometimes, a lot of help. In many families, parents are simultaneously helping their children as well as their own parents. And the impact on adult children and their siblings can take a toll on finances, emotions and careers.

A Pew Research Center report in 2015 found that 60 percent of adults in the U.S who have at least one parent age 65 or older had provided help with errands, housework, home repairs, or personal care within the past 12 months. Nearly 30 percent had provided financial help within that time period.[i] Other key findings were that although 88 percent who were helping their parents found it rewarding, a third also said it was stressful. And 76 percent viewed providing financial assistance to their aging parents in need as their responsibility.

Whether aging parents need practical help or financial help, it’s critical for adult children and siblings to work together on a plan. Ideally they can hold a family discussion before problems and needs arise to determine how each will help. The family might also choose to meet with a financial advisor to discuss a financial plan for costs related to elderly parents’ care or other expenses. But even if decisions must be made quickly due to sudden illness or other unexpected conditions, the adult children can work to reach agreement on a plan of action. It can be especially challenging to split responsibilities when one lives near and other siblings live elsewhere.

We’ve identified some needs and circumstances that could arise for aging parents and how adult children can help manage them. We’ve also included lists of resources that can be helpful.

Helping parents in their own home

As detailed in the Pew study, the vast majority of adult children are willing to help their parents as they age, both financially and with practical or personal care. But for many, the help they expect to provide can be different from what their parents actually need. A 2015 study of those who provide care to an elderly relative or friend by Northwestern Mutual found a disconnect between experienced and non-experienced caregivers.[ii] Although both caregiver groups provided high levels of practical help such as personal care, grocery shopping, cooking, cleaning, laundry and home maintenance, the experienced group reported that emotional support outranked many of the chores in importance, something the newcomers did not anticipate.

That said, helping elderly parents with practical help such as managing medical appointments and organizing finances can benefit the entire family. Although some parents initially might bristle, thinking their children believe they are incapable, a thoughtful family conversation can make it clear that accepting help means they can remain in their own home for a longer period of time. Providing help – by doing it themselves or hiring others – so their parents can stay comfortably in their home can be rewarding for adult children as well.

When a parent needs additional help – providing in-home care, moving into assisted living or nursing care

If parents are not able to live safely and comfortably in their home, even with help from others, families must consider next steps, such as providing in-home care, or having the parent move to assisted living or a nursing home. These are among the most difficult decisions and it’s critical that everyone, including elderly parents, is part of the conversation. You might think it’s obvious that you want only what’s best for your elderly parents, but that doesn’t necessarily mean you know what that is or are aware of what they want. And getting input from health care professionals can also shed light on what is best. Most importantly, elderly parents, if they are able, should be equals in the discussion and planning process.

Once a decision is made, families must determine what they can afford and how to assess quality of care. The 2015 Genworth Financial Cost of Care Survey[iii] found that the median annual cost per person for in-home care was about $45,000 for daytime only care. Round-the-clock care can range from $200 to $350 per day, depending on location and level of care needed, for an annual cost of as much as $75,000 to $125,000.[iv] The median for a one-bedroom unit in assisted living was $43,200 and nursing home care was $80,300 for a semi-private room and $91,250 for a private room, according to the Genworth survey. It’s advisable to check with state or federal agencies such as Veterans Affairs to see whether a parent qualifies for financial assistance, in addition to private funds or long-term care insurance that might be available.

Evaluating assisted living or nursing homes is best done on site and there are numerous public and private resources with advice on what to look for. Basics include checking for licensing, overall cleanliness, staffing levels, food, safety and activities to find those that are best suited to the elderly parent. Caregiver Web sites and organizations have similar standards for how best to evaluate an individual or agency that will provide in-home care. Ultimately, it’s subjective – the parents and adult children will need to choose care that feels the most comfortable at the level they need and can afford.

If an adult child gives up a job to care for elderly parents, either by choice or because the parents can’t afford professional care, it’s important for the family to recognize the magnitude of that decision. Determining compensation, if any, for the caregiver can be sensitive and must be handled equitably and with transparency to help prevent sibling rivalry or resentment. Some families draw up a formal caregiving contract and pay a child or children for the care they provide. If there is a family trust, another option is to include a provision to allow direct and indirect expenses to be paid to a child who provides care. An attorney or financial advisor can help a family plan for and implement these arrangements. Whenever possible, family members should discuss options in advance and try to arrive at consensus.

Approaching your parents when you think they need financial help or when you believe they no longer can handle their affairs is among the most difficult of conversations. Even the most astute individuals can be challenged when handling finances. Recognizing a decline in yourself or others can be complicated, a scenario that’s becoming more common as lifespans increase and individuals need to make financial, medical and legal decisions into their 80s and beyond.

Ideally, adult children can discuss the situation with an elderly parent and offer help, either from family members or outside professionals well before they actually need it. But sometimes that isn’t possible. And if a parent is unwilling or reluctant, a financial planner or elder law attorney might be able to start the discussion. Depending on the circumstance, parents can give children or others power of attorney for financial and legal decisions, and power of attorney for health care, to be activated immediately or when needed. If a parent no longer is competent, an adult child can be named a guardian and then would have complete responsibility for a parent’s care, finances and overall wellbeing.

If elderly parents don’t have the financial means to pay for their care and related expenses, adult children often must step in. It’s best if the children work together and assess their parents’ financial situation as early as possible and determine whether any or all of them can help and in what way. For example, children could agree to cover expenses up front and be reimbursed later after the parents’ home is sold. Children who help support their parents or cover medical or other expenses should be aware of tax implications, depending on the level of support

Ultimately, caring for elderly parents can be extremely rewarding, a time when a family can join together to provide care and support. But it also can be complicated and stressful, especially if there are multiple siblings in different locations all trying to determine what’s best for mom and dad. Family history and dynamics play a major role, as do financial and medical considerations. If adult children can focus on strong communication and view their elderly parents’ care and wellbeing as a shared responsibility, they can work together to keep their parents comfortable and safe as they age.